Early Outcomes of Pyrolytic Carbon Hemiarthroplasty for the Treatment of Trapezial-Metacarpal Arthritis

J. S M de Aragon, Steven Lawrence Moran, Marco Rizzo, Kirsten B. Reggin, Robert D. Beckenbaugh

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Purpose: Pyrolytic carbon implants have been successfully used in the treatment of osteoarthritis of the metacarpophalangeal and proximal interphalangeal joints. Recently, pyrolytic carbon hemiarthroplasties have been proposed for the treatment of osteoarthritis of the trapezial-metacarpal (TM) joint of the thumb. We wished to review our short-term outcomes for this device in the treatment of TM arthritis. Methods: Fifty-four arthritic TM joints in 49 patients, with a mean age of 59 years, were treated with use of a pyrolytic carbon hemiarthroplasty procedure. Underlying diagnoses included osteoarthritis in 44 thumbs, rheumatoid arthritis in 8 thumbs, psoriatic arthritis in 1 thumb, and juvenile rheumatoid arthritis in 1 thumb. The patients were followed up clinically as well as radiologically for an average of 22 months postoperatively. Results: The overall 22-month survival rate excluding scaphotrapezio-trapezoidal joint arthritis was 80% according to a Kaplan-Meier analysis. Ten metacarpal subluxations were observed. Seven of these cases were salvaged by increasing the depth of the trapezial cup. A total of 15 reoperations were required in this cohort. No complications were seen in the patients with inflammatory arthritis. Thirty-five patients were pain free at the latest follow-up, and 6 reported mild to occasional pain with repetitive activities. The overall satisfaction rate was 40 of 49 patients (81%). Grip strength recovered to 86% of that of the contralateral side. Apposition key and opposition pinch strength improved to 92% and 95%, respectively, of those of the contralateral hand. Conclusions: Pyrolytic carbon thumb arthroplasty may prove to be an acceptable option for the treatment of TM, although a high complication rate was observed in this early cohort, with many cases of subluxation attributed to the creation of a too shallow trapezial cup. Further comparative studies are warranted. Type of study/level of evidence: Therapeutic IV.

Original languageEnglish (US)
Pages (from-to)205-212
Number of pages8
JournalJournal of Hand Surgery
Volume34
Issue number2
DOIs
StatePublished - Feb 2009

Fingerprint

Hemiarthroplasty
Metacarpal Bones
Thumb
Arthritis
Joints
Osteoarthritis
Therapeutics
Pinch Strength
Psoriatic Arthritis
Juvenile Arthritis
Kaplan-Meier Estimate
Hand Strength
Reoperation
Arthroplasty
pyrolytic carbon
Rheumatoid Arthritis
Survival Rate
Hand
Pain
Equipment and Supplies

Keywords

  • Arthroplasty
  • pyrocarbon
  • thumb arthritis

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Early Outcomes of Pyrolytic Carbon Hemiarthroplasty for the Treatment of Trapezial-Metacarpal Arthritis. / de Aragon, J. S M; Moran, Steven Lawrence; Rizzo, Marco; Reggin, Kirsten B.; Beckenbaugh, Robert D.

In: Journal of Hand Surgery, Vol. 34, No. 2, 02.2009, p. 205-212.

Research output: Contribution to journalArticle

de Aragon, J. S M ; Moran, Steven Lawrence ; Rizzo, Marco ; Reggin, Kirsten B. ; Beckenbaugh, Robert D. / Early Outcomes of Pyrolytic Carbon Hemiarthroplasty for the Treatment of Trapezial-Metacarpal Arthritis. In: Journal of Hand Surgery. 2009 ; Vol. 34, No. 2. pp. 205-212.
@article{3443914ea94e49ce9f0d4cfb278d0263,
title = "Early Outcomes of Pyrolytic Carbon Hemiarthroplasty for the Treatment of Trapezial-Metacarpal Arthritis",
abstract = "Purpose: Pyrolytic carbon implants have been successfully used in the treatment of osteoarthritis of the metacarpophalangeal and proximal interphalangeal joints. Recently, pyrolytic carbon hemiarthroplasties have been proposed for the treatment of osteoarthritis of the trapezial-metacarpal (TM) joint of the thumb. We wished to review our short-term outcomes for this device in the treatment of TM arthritis. Methods: Fifty-four arthritic TM joints in 49 patients, with a mean age of 59 years, were treated with use of a pyrolytic carbon hemiarthroplasty procedure. Underlying diagnoses included osteoarthritis in 44 thumbs, rheumatoid arthritis in 8 thumbs, psoriatic arthritis in 1 thumb, and juvenile rheumatoid arthritis in 1 thumb. The patients were followed up clinically as well as radiologically for an average of 22 months postoperatively. Results: The overall 22-month survival rate excluding scaphotrapezio-trapezoidal joint arthritis was 80{\%} according to a Kaplan-Meier analysis. Ten metacarpal subluxations were observed. Seven of these cases were salvaged by increasing the depth of the trapezial cup. A total of 15 reoperations were required in this cohort. No complications were seen in the patients with inflammatory arthritis. Thirty-five patients were pain free at the latest follow-up, and 6 reported mild to occasional pain with repetitive activities. The overall satisfaction rate was 40 of 49 patients (81{\%}). Grip strength recovered to 86{\%} of that of the contralateral side. Apposition key and opposition pinch strength improved to 92{\%} and 95{\%}, respectively, of those of the contralateral hand. Conclusions: Pyrolytic carbon thumb arthroplasty may prove to be an acceptable option for the treatment of TM, although a high complication rate was observed in this early cohort, with many cases of subluxation attributed to the creation of a too shallow trapezial cup. Further comparative studies are warranted. Type of study/level of evidence: Therapeutic IV.",
keywords = "Arthroplasty, pyrocarbon, thumb arthritis",
author = "{de Aragon}, {J. S M} and Moran, {Steven Lawrence} and Marco Rizzo and Reggin, {Kirsten B.} and Beckenbaugh, {Robert D.}",
year = "2009",
month = "2",
doi = "10.1016/j.jhsa.2008.10.018",
language = "English (US)",
volume = "34",
pages = "205--212",
journal = "Journal of Hand Surgery",
issn = "0266-7681",
publisher = "W.B. Saunders Ltd",
number = "2",

}

TY - JOUR

T1 - Early Outcomes of Pyrolytic Carbon Hemiarthroplasty for the Treatment of Trapezial-Metacarpal Arthritis

AU - de Aragon, J. S M

AU - Moran, Steven Lawrence

AU - Rizzo, Marco

AU - Reggin, Kirsten B.

AU - Beckenbaugh, Robert D.

PY - 2009/2

Y1 - 2009/2

N2 - Purpose: Pyrolytic carbon implants have been successfully used in the treatment of osteoarthritis of the metacarpophalangeal and proximal interphalangeal joints. Recently, pyrolytic carbon hemiarthroplasties have been proposed for the treatment of osteoarthritis of the trapezial-metacarpal (TM) joint of the thumb. We wished to review our short-term outcomes for this device in the treatment of TM arthritis. Methods: Fifty-four arthritic TM joints in 49 patients, with a mean age of 59 years, were treated with use of a pyrolytic carbon hemiarthroplasty procedure. Underlying diagnoses included osteoarthritis in 44 thumbs, rheumatoid arthritis in 8 thumbs, psoriatic arthritis in 1 thumb, and juvenile rheumatoid arthritis in 1 thumb. The patients were followed up clinically as well as radiologically for an average of 22 months postoperatively. Results: The overall 22-month survival rate excluding scaphotrapezio-trapezoidal joint arthritis was 80% according to a Kaplan-Meier analysis. Ten metacarpal subluxations were observed. Seven of these cases were salvaged by increasing the depth of the trapezial cup. A total of 15 reoperations were required in this cohort. No complications were seen in the patients with inflammatory arthritis. Thirty-five patients were pain free at the latest follow-up, and 6 reported mild to occasional pain with repetitive activities. The overall satisfaction rate was 40 of 49 patients (81%). Grip strength recovered to 86% of that of the contralateral side. Apposition key and opposition pinch strength improved to 92% and 95%, respectively, of those of the contralateral hand. Conclusions: Pyrolytic carbon thumb arthroplasty may prove to be an acceptable option for the treatment of TM, although a high complication rate was observed in this early cohort, with many cases of subluxation attributed to the creation of a too shallow trapezial cup. Further comparative studies are warranted. Type of study/level of evidence: Therapeutic IV.

AB - Purpose: Pyrolytic carbon implants have been successfully used in the treatment of osteoarthritis of the metacarpophalangeal and proximal interphalangeal joints. Recently, pyrolytic carbon hemiarthroplasties have been proposed for the treatment of osteoarthritis of the trapezial-metacarpal (TM) joint of the thumb. We wished to review our short-term outcomes for this device in the treatment of TM arthritis. Methods: Fifty-four arthritic TM joints in 49 patients, with a mean age of 59 years, were treated with use of a pyrolytic carbon hemiarthroplasty procedure. Underlying diagnoses included osteoarthritis in 44 thumbs, rheumatoid arthritis in 8 thumbs, psoriatic arthritis in 1 thumb, and juvenile rheumatoid arthritis in 1 thumb. The patients were followed up clinically as well as radiologically for an average of 22 months postoperatively. Results: The overall 22-month survival rate excluding scaphotrapezio-trapezoidal joint arthritis was 80% according to a Kaplan-Meier analysis. Ten metacarpal subluxations were observed. Seven of these cases were salvaged by increasing the depth of the trapezial cup. A total of 15 reoperations were required in this cohort. No complications were seen in the patients with inflammatory arthritis. Thirty-five patients were pain free at the latest follow-up, and 6 reported mild to occasional pain with repetitive activities. The overall satisfaction rate was 40 of 49 patients (81%). Grip strength recovered to 86% of that of the contralateral side. Apposition key and opposition pinch strength improved to 92% and 95%, respectively, of those of the contralateral hand. Conclusions: Pyrolytic carbon thumb arthroplasty may prove to be an acceptable option for the treatment of TM, although a high complication rate was observed in this early cohort, with many cases of subluxation attributed to the creation of a too shallow trapezial cup. Further comparative studies are warranted. Type of study/level of evidence: Therapeutic IV.

KW - Arthroplasty

KW - pyrocarbon

KW - thumb arthritis

UR - http://www.scopus.com/inward/record.url?scp=58749104056&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=58749104056&partnerID=8YFLogxK

U2 - 10.1016/j.jhsa.2008.10.018

DO - 10.1016/j.jhsa.2008.10.018

M3 - Article

C2 - 19181221

AN - SCOPUS:58749104056

VL - 34

SP - 205

EP - 212

JO - Journal of Hand Surgery

JF - Journal of Hand Surgery

SN - 0266-7681

IS - 2

ER -